Summary and Discussion

The population of the Philippines is still young but is slowly ageing. The country’s long history of high fertility and its slow decline, combined with the modest improvement in mortality has contributed to the slow pace of population ageing in the Philippines. Although the increase in the proportion of Filipino older persons has been very modest, the increase in the absolute number has been substantial: from 1.6 million in 1970 to 6.2 million in 2010. This puts the Philippines in a challenging situation of catering for the basic needs of a young population and at the same time providing for the health care needs of its growing number of older population.

There are also pronounced differences in the demographic and socioeconomic profile of older persons in the Philippines. The “feminisation of elderly” observed in many countries is also apparent in the Philippines (Domingo, 1994; Knodel & Chayovan, 2009) and has slightly intensified over time. This excess of women over men at older ages has been viewed negatively because it reflects high levels of widowhood and older women, particularly those without a spouse, are deemed disadvantaged compared with older men (Knodel, 1999). However, while the predominance of women at older ages has been considered problematic, some factors could work to their advantage (Knodel, 1999; Sobieszczyk et al., 2003). For example, women may suffer less disruption in the performance of their major roles as they enter old age compared with men who may experience discontinuity associated with their exit from the job market (Gibson, 1996). Older women may also be considered more valued members of the household than non-working older men, because of their greater contribution in terms of performing domestic chores (Knodel, 1999).

This chapter also shows that ageing in the Philippines is mostly a rural phenomenon. Older Filipinos who are in their 60s are more likely to live in urban areas, including Metro Manila, while those in their 70s or 80+ are more likely to live in rural areas. The relative concentration of oldest old in the rural areas, where access to health care facility is limited, is worrisome since it is at oldest ages where the incidence of disease and disability is generally high. Furthermore, the outmigration of young people from rural to urban areas could also potentially diminish the available pool of caregivers to the oldest old Filipinos in rural areas.

Appreciable differences in the marital status composition of older men and women in the Philippines are also noted. Specifically, higher proportions of older Filipino men are currently

81

married, while higher proportions of older Filipino women are widowed. This pronounced sex difference in marital status could have important implications for the well-being of older Filipinos. The presence of spouse among older Filipino men could work to their advantage as “spouses act as a small insurance pool against life’s uncertainties, reducing their need to protect themselves against unexpected events” (Waite, 2009, p. 691). In contrast, the absence of a spouse may put widowed older women in a disadvantaged position due to loss of financial resources (Holden & Smock, 1991).

Concomitant with the population ageing in the Philippines are significant changes in the socioeconomic characteristic of older people, particularly education. Over time, the share of older persons with no education significantly declined, whereas those with above secondary education sharply increased. Given the association between higher levels of education and better health status (Zimmer & Amornsirisomboon, 2001), the observed improvement in education bodes well for the current and future cohort of older Filipinos. Older Filipino men, those who are in the younger cohort, those living in urban areas and who have never married may reap more the benefits of having a better education than their counterparts. Their high level of education could present better work opportunities for them that could translate to better economic status later in life (Knodel & Chayovan, 2009).

Given the long history of high fertility in the Philippines, the current generation of older Filipinos is assured of a bigger household size from which they can draw support. Coresidence with children, which can serve as an indicator of family support, is generally high and has remained stable over time. However, while this may reflect the resilience of filial obligations toward older people, caution should be taken in automatically equating coresidence with the presence of support or provision of care for older people (Hermalin, 2002). As argued by Chan (2005, p. 277) living with a child “is not evidence in and of itself of a net flow of resources from child to parent, or that coresidence reflects the parent’s needs”. Earlier studies in the Philippines and Indonesia suggest that parents in a coresidential arrangement may be the one providing support to their children, and not the other way around, especially if the children are still young and have not established their independence (Beard & Kunharibowo, 2001; Domingo & Casterline, 1992). Similarly, noncoresidence with children does not necessarily mean an absence of support (Knodel & Saengtienchai, 1999). For example, the PSOA data show that older Filipinos received both financial (87.3%) and non-financial (73.7%) support from their non-coresident children (Cruz et al., 2016). This suggests that information on living

82

arrangements among older people should be complemented with information on actual exchange of support between older people and their children who are living within and beyond the household to get a more nuanced picture of the intergenerational exchange of support in the country.

The overall household conditions of older people in the Philippines are generally favourable. Most older Filipinos live in a housing unit that is of acceptable quality, although a significant proportion still lives in less than ideal housing condition. Their access to household necessities, such as appropriate lighting, potable water, and decent toilet facility is generally high but far from universal. Lack of access to these household necessities may further exacerbate the difficulty experienced by those who need assistance in carrying out ADLs, such as bathing and using the toilet. On the positive side, a significant share of older Filipinos has access to some household possessions, such as radio and television that can play an essential role in their recreation and social life.

83

4

Chapter 4: Children’s education and parental health in the

Philippines

4.1 Introduction

A great number of studies have investigated the impact of older adults’ own socioeconomic resources on their own health status (Hosseinpoor et al., 2012; Zimmer, 2006). However, health crises usually involve family networks, particularly adult children, who may provide not only caretaking roles but also substantial material and non-materials resources (Zimmer et al., 2002a). In addition, children may also influence the health status of their parents through social support and social influence (Torssander, 2013). Some argue that focusing only on the socioeconomic position of the individual will underestimate the degree of health inequality; thus it is also important to consider the position of other family members (Torssander, 2014; Zimmer et al., 2002a).

The growing recognition of the influence of an individual’s resources on another person’s health has provided an impetus for more research on this topic. Several studies in developed countries have demonstrated the important role of adult children’s education in the physical functioning and survival of their elderly parents (Friedman & Mare, 2014; Lee & Chuang, 2003; Torssander, 2013; Zimmer et al., 2002a; Zimmer et al., 2007). For example, older people in Taiwan and Mexico with highly educated children are less likely to report functional limitations compared with their counterparts with less educated children (Yahirun et al., 2016; Zimmer et al., 2002a).

Some of these earlier studies suggest that the relationship between children’s education and parental health could be stronger in settings where coresidence between adult children and their parents is common, such as in most developing countries (Torssander, 2013; Zimmer et al., 2002a). However, very limited evidence exists in developing countries to support this claim (De Neve & Harling, 2017; Yahirun et al., 2016; Yang et al., 2016). Furthermore, previous studies have focused only on functional limitation or mortality as indicators of health outcome. As discussed in chapter 1, these two indicators are important components of the disablement process, with mortality as the terminal outcome. However, other important components of the disablement process, such as impairment which corresponds to the early stage of the disablement process and disability which correspond to the advanced stage of this process, have not been investigated in relation to children’s education. To address this gap, this study

84

broadens the definition of health to capture the different stages of the disablement process. In addition, to functional limitation, this research uses the presence of chronic disease and disability in IADL and ADL, as health indicators. Mortality is not examined here due to data limitations. Employing a more comprehensive definition of health will help us understand whether the influence of children's education is dependent on the stage in the disablement process in which their parents are in.

In sum, this chapter has three main objectives. First, it examines the association between children’s education and parental health using multiple indicators of health. Second, it investigates whether the influence of children’s education on parental health is similar for low and highly educated parents. Do low-educated parents benefit more from having highly educated children compared with parents who have high levels of education? Third, this chapter explores whether changing parents’ health behaviour is one of the pathways by which children’s education influence their parents’ health.